Bryan, a 10-year-old African American boy, came to our clinic with his mother for his annual physical exam and follow up immunization. Bryan is 4 feet 9 inches tall and weighs 210 lbs. During the examination, I noted that Bryan walked sluggishly as a result of his weight and has had asthma since the age of 7 years.
Bryan wants to be a policeman or fireman, but right now he gets tired going up the stairs to his second floor class. His dietary intake is high in fat and carbohydrates, and he consumes low-nutrient snacks, such as cookies, sweetened juice and soda. He rarely exercises. Bryan’s mother believes that obesity is natural in their family and that her son’s obesity has no connection with his lack of exercise or eating pattern.
Although Bryan is asthmatic, obesity increases his risk for other medical conditions such as diabetes, hypertension and arthritis and can affect his psychological and social well being. His obesity is a problem for his family and our community. Bryan’s weight is a concern to me as a practitioner. My effort is needed to help him reach and maintain an appropriate body weight, and thereby improve his quality of life.
According to National Health and Nutrition Examination Survey, 17% of U.S. children and adolescents aged 2 to 19 years are overweight, a number that has tripled since the early 1960s. Obesity and its associated health problems pose a significant economic burden on our healthcare system.
In 2002, the national health costs related to childhood obesity was $92.6 million and Medicaid paid about half of these costs. Public health officials have noted that nearly $5 billion is spent annually in New York State alone for obesity related health costs, accounting for 5% of all of the state’s Medicaid.
As a Nurse Practitioner practicing in impoverished communities, I have witnessed disparity in childhood obesity among African Americans and Hispanics. New York Department of Health statistics reveal that one-in-six black and Hispanic children are overweight or obese. These same groups experience obesity at higher rates than other racial groups, according to the CDC.
Obesity prevalence among blacks is 51% compared with a 21% prevalence among whites. The growth of childhood obesity among blacks and Hispanics increased about 120% between 1986 and 1998, according to NHANES data. Among whites, obesity has also increased 50%.
These statistics reinforce the importance of the Healthy People 2020 goal of preventing obesity in childhood. The report from Racial Disparities in Childhood Obesity 2011 indicates that there are number of reasons why minorities have higher obesity rates:
- Lack of adequate access to health information
- Dietary patterns and accessibility to healthy food options<!–
- Limited access to recreational activities
- Reduced access to primary care
- Low levels of education
- Cultural attitude about body weight.
Blacks and Hispanics do not consider obesity to be a negative trait, which has led to cultural acceptance of this unhealthy condition. Our national obesity goals should encompass efforts to reduce disparities that are reinforced by racial, social, economic and environmental factors.
I personally support “fat tax” legislation for snack foods, sweetened-drinks and soda. I believe the revenues generated from such a tax should be allocated for nutrition and exercise programs for obese children and to educate families about the importance of diet and exercise.
“Fat tax” opponents include the beverage, soda and snack industries and lobbies, who believe that the proposed sales tax will affect mainly low-income families. These obesity-intervention critics also contend the government should not be monitoring cookie or snack intake, because this encroaches on the private lives and personal choices of citizens.
Although this may be true, I believe soda and snack taxes would have a modest effect on overall consumption, but could generate billions of dollars to be used for campaigns to reduce childhood obesity, especially among minority groups. Lawmakers must consider this and implement a comprehensive approach to address the epidemic of childhood obesity. Doing nothing will virtually guarantee that current obesity problem will continue to threaten the nation’s future and increase the financial burden on our healthcare system.
I encourage health care providers and parents of obese children to support taxes on soda and snacks, and be selective about their children’s foods choices at school. I also recommend parents advocate for schools to promote regular exercise, and influence the government to build more recreational centers and primary-care health centers in their communities, so children like Bryan will grow up healthy.
Stella Ikwuazom is a board certified Family Nurse Practitioner who is a primary care provider in Queens, NY.